Surgical Remove of Cancerous Tissue

The primary therapy for all forms of thyroid cancer is surgery. The generally accepted approach is to remove the entire thyroid gland (total thyroidectomy). 

The thyroid gland has two lobes. If a patient is known to have thyroid cancer before surgery, the entire gland and possibly surrounding lymph nodes are removed. If a patient has a thyroid nodule affecting just one lobe that is not known to be a cancer prior to surgery, only half of the gland normally needs to be removed at the time of the initial surgery.

  • For cases that involve the removal of only one lobe of the thyroid gland for a nodule(s) presumed benign, a pathologist evaluates the resected tissue while the patient is still in the operating room. If the nodule(s) are judged to be malignant, the surgeon may then remove the entire thyroid gland at the time of the initial surgery.
  • A few weeks after surgery, patients who did have cancer will receive a single oral dose of radioactive iodine to destroy any microscopic thyroid cells that may remain.
  • Patients who have had their entire thyroid removed (and some who have had a partial removal) need to take thyroid hormone supplements for the rest of their lives.

The standard treatment for adrenal cancer and neuroendocrine tumors is also surgical removal of the cancerous tissue. Some neuroendocrine cancers, especially those that occur in the liver, can be treated using chemoembolization, a minimally invasive interventional radiology technique.

Overnight Pathology for Thyroid Patients

While a pathologist routinely performs an initial thyroid tissue evaluation during surgery for all nodules that are not known to be cancerous, a more comprehensive analysis is still necessary to produce a final pathology report. In rare cases, if the final report shows cancer in tissue that was initially thought to be cancer-free, the patient may need another operation to remove the entire thyroid gland.

In most hospitals, the final pathology report is produced several days after the initial thyroid surgery. Therefore, if a patient needs a second operation to remove the remaining thyroid gland, he or she must be readmitted to the hospital. 

The pathologists in the Endocrine Cancer Program at Froedtert & the Medical College of Wisconsin have committed to providing the final pathology for thyroid patients in less than 24 hours. That way, if a patient needs an additional surgery, it may be done during the same hospital stay, typically the day after the initial surgery.

Radioactive Iodine Therapy

A major reason for the usually excellent prognosis for patients with papillary and follicular thyroid cancer is that radioactive iodine (RAI) is used to seek out and destroy thyroid cancer cells with little or no damage to other tissues in the body. 

Radioactive iodine is a radioactive isotope that gives off radiation. There are two radioactive isotopes that can be used — I-123 and I-131. These isotopes can be given by mouth to patients with suspected thyroid conditions. RAI is then concentrated inside thyroid cells exactly like iodine and can be used to diagnose or treat thyroid problems. The radiation that RAI gives off can be harmless to the thyroid cells (I-123) or the radiation may destroy the thyroid cells (I-131). RAI that is not concentrated in the thyroid gland is eliminated from the body through sweat and urine. 

Having high levels of thyroid stimulating hormone (TSH) causes thyroid cancer cells left after surgery to take up significant amounts of iodine. This will occur by making your body hypothyroid by either stopping thyroid hormone pills or not starting hormone pills after surgery. Once TSH levels are high enough, a whole body iodine scan is done by administering a small dose of radioactive iodine by mouth to determine if there are remaining thyroid cells that need to be destroyed. If enough cells show up on the scan, a large dose of radioactive iodine is given and then the thyroid pills are re-started. 

Follow-up Care After Treatment

Periodic physical exam will usually be performed by an endocrinologist. Follow-up may also include ultrasound examinations and radioactive body scans. Follow-up will also include thyroid hormone replacement (levothyroxine) to replace the function of the thyroid and to decrease the likelihood of cancer recurrence. 

Routine blood tests will also be performed. Thyroid function tests are usually performed four to six weeks after medication is started to determine if the correct dose of thyroid hormone medication is being taken. In addition, a thyroglobulin level will be measured at follow-up appointments. Thyroglobulin is a thyroid cell protein that serves as a thyroid cancer marker.

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